Seminar to help staff navigate prescription drug claim issue

My association (Canadian Group Insurance Brokers – CGIB.CA) is holding a seminar for brokers, insurers and employers on Wednesday February 28th from 8 am until noon in Vaughan.  Tickets are $175 but FREE to Mainstay clients.  We have a limited number of seats available, so if you are interested in attending, please send me an e-mail before THIS Friday at 5pm to hold a spot.  Details are below…

Employees are asking employers questions when; a claim is not paid, a generic drugs is substituted for brand, Prior Authorization questions are asked, there are delays in dispensing their drugs, or they are told that drugs will only be paid for and dispensed by certain pharmacies.

Clients are often faced with an employee that says “you can’t make me take these pills, or tell me where to shop”. We’ll help provide you with the right answer to share that will help to deal with those conversations quickly and efficiently.  The presentations also cover; navigating the “system” to help support staff, identifying tools that are available to assist employees, as well as patient support programs that can improve health outcomes.

Information and directions are below.  But let us know if you’re interested, and we’ll book a spot at no charge to you.

Have a youth that has a drug claim declined?

We have had some feedback from clients (very few) that their employees with dependent children age 24 and under are having issues with the new OHIP+ program.  This issue is caused when someone under age 25 is using what is called an EAP drug.  In the past, these drugs would normally be covered by the private employer benefit plan. The province is now covering this with OHIP+ as of January 1st, 2018.  This means that the private plans will NOT pay for these drugs until the province has declined coverage.

There is more information on the provincial website link below, as well as the list of the over 1000 EAP Drug ID Numbers (DINS) that need special application forms completed…

A look at the five-year forecast for drug plan cost increases

Employers will see private drug plan costs rise by about six per cent annually over the next five years, according to a prediction by a health-care research company.

Brad Millson, principal of health access and outcomes at IQVIA, presented the results of his firm’s 2017-21 forecast, produced in partnership with Innovative Medicines Canada, at Benefits Canada’s 2017 Face-to-Face Drug Plan Management forum on Dec. 14.

Ontario’s Bill 177 Brings Big Changes for Employer’s Workplace Safety Obligations

Close on the heels of the sweeping changes brought about by Bill 148, the Ontario government has enacted another set of changes to Ontario’s employment laws. Bill 177, the Stronger, Fairer Ontario Act (Budget Measures), 2017, is omnibus legislation that affects a number of Ontario statutes, including the Occupational Health and Safety Act (OHSA), as well as transitional updates to the Workplace Safety and Insurance Act, 1997 (WSIA).



A decision of the Ontario Divisional Court helps answer questions on how employers can handle employee medical notes or doctor’s recommendations that don’t seem quite right. In ‘Ontario Employers’ Right To Request Independent Medical Examinations’ at the Benefits and Pensions Monitor website, Laurie Jessome, a partner specializing in employment law and chair of the advocacy group at Cassels Brock, explains how in Bottiglia v. Ottawa Catholic School Board, 2017, the Divisional Court says employers do not need legislative or contractual authority to require that an employee submit to an independent medical examination as long as they have reasonable and bona fide grounds for requesting the examination.

excerpt from Benefits and Pension Monitor – ONLINE

Global health-care plan costs to rise faster than inflation in 2018: report

The average cost increases for employer-sponsored health-care plans are set to increase at a faster rate than inflation in 2018, according to a new report by Aon…

…Canada is not too far behind with an expected six per cent rise in costs for extended health-care plans. After inflation of 2.1 per cent, the projected cost increase is 3.9 per cent. That’s compared to an overall cost increase of eight per cent in 2017 and a net rise of 6.1 per cent. The report notes this increase is currently trending lower relative to the rest of North America and the world, reversing a multi-year trend.